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Treatment Of Thumb Sucking

Thumb Sucking in children usually starts at the age of 6 months, at times before birth. Children have a natural tedency to suck. This habit may involve sucking of thumb, digits or pacifiers. Children develop this habit to suck whenever they are hungry, tired, restless, bored or sleepy. 90% children stop by the age of 3-6yrs. If it continues beyond that it needs to be treated.

For the treatment to be successful, one should first make the child awared of the consequences thumb sucking might have.

The treatment plan can be broadly divided into the following:

Psychological Therapy

1. Screen the patient for the underlying psychological disturbances that sustain a thumb sucking habit. Once psychological dependence is suspected, the child is referred to professionals for counseling. Dont start the treatment if the child is undergoing emotional turmoil such as loss of favorite toy, of a pet etc.

2. Thumb sucking children between the ages of 4 and 8 years of age need only reassurance, positive reinforcement and friendly reminders. Awareness of the habit can be accomplished by emphasizing the positive aspects of habit cessation. Various aids are employed to bring the habit under the notice of the child such as study models, mirrors, etc.

3. Children and parents are informed about existing dentofacial deformities and the long-term risks of a sustained habit. Patients should be presented with positive mental and visual images of the dentofacial ideals expected from habit cessation and subsequent orthodontic treatment.

4. During the treatment adequate emotional support and concern should be provided to the child by the parents.

5. Destructive approaches in the form of nagging, shamming and belitting ought to be strictly avoided.

6. Constant reassurance and encouragement should be provided to the patient to gain his confidence.

7. The use of positive behavior modification techniques and even hypnosis has been effective in digit habit therapy. When the habit is discontinued, the child can be rewarded with a favorite new toy or special outing.

8. Engage the child in activites he/ she enjoys so that he forgets to suck.

9. Talk openly (if he understands) to your child about the speech and dental consequences.

10. Praising the child in front of others for his efforts to stop his habit and asking him to encourage others to do so.

Dunlop’s beta hypothesis

He believed that if a subject can be forced to concentrate on the performance of the act at the time he practices it, he can learn to stop performing the act. Forced purposeful repetition of a habit eventually associates it with unpleasant reactions and the habit is abandoned. The child should be asked to sit in front of a mirror and asked to suck his thumb, observing himself as he indulges in the habit.

Reminder Therapy

This can be divided into the following

Extra oral approaches

It employs hot tasting, bitter flavored preparations or distasteful agents that are applied to finger or thumbs. For example, Cayenne pepper, quinine, asafetida. This is effective only when the habit is not firmly entrenched.

Thermoplastic thumb post was devised by Allen in 1991 where a thermoplastic material was placed on the offending digit. A total of 6 weeks of treatment time was required for elimination of habit.A thumb post is placed over the thumb with wrist bands covering the wrist.These bands come in various colors so that the child feels great wearing them.

Intraoral Approaches

Various orthodontic appliances are employed to attenuate and eventually break the habit.

Hawley’s retainer with and without spurs. Fixed appliances such as upper lingual tongue screens appear to be more effective in breaking these habits. If the child has made appreciable changes in his habit by 3 months, the appliances can be safely removed for a testing period. If gross signs of anxiety are aroused e.g. bed wetting, bad dreams, etc, the appliance should be removed.

Mechanotherapy

Fixed intra-oral anti thumb sucking appliance

Most effective mechanical deterrent to thumb sucking is an intraoral appliance attached to the upper teeth by means of bands fitted to the primary second molars or the first permanent molar. A lingual arch forms the base of the appliances to which are added interlacing wires in the anterior portion in the area of the anterior part of the hard palate. It works by preventing the patient from putting the palmer surface of the thumb in contact with the palatal gingival, thereby robbing the pleasure of sucking.

Blue grass appliance

Haskell (1991) introduced this appliance, for children with a continued thumb sucking habit, which is affecting the mixed or permanent dentition. It consists of a modified six sided roller machined from Teflon to permit purchase of the tongue. This is slipped over a 0.045 stainless steel wire soldered to molar orthodontic bands. This appliance is placed for 3-6 months. Instructions are given to turn the roller instead of sucking the digit. Digit sucking is often seen to stop immediately.

Quad helix

This appliance prevents the thumb from being inserted and also corrects the malocclusion by expanding the arch.